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ACNE VULGARIS

ACNE VULGARIS. DR RAMINDER SAWHNEY GPR 17/2/05. ACNE - Goals. Decrease scarring Decrease unsightly appearance Decrease psychological stress

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ACNE VULGARIS

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  1. ACNE VULGARIS DR RAMINDER SAWHNEY GPR 17/2/05

  2. ACNE - Goals • Decrease scarring • Decrease unsightly appearance • Decrease psychological stress • Explain long length of treatment may be several months and initial response may be poor but must persevere (poor compliance has been demonstrated in studies at3/12)

  3. ACNE – What is it? • Disease of pilosebaceous follicle • Non-inflammatory Comedones - open blackhead - closed whitehead • Inflammatory - papules, - pustules, - nodules - scarring

  4. Acne vulgaris comedones dominant

  5. Acne vulgaris- pus dominant

  6. Acne Treatment • Benzoyl peroxide-(cheap+cheerful) • Start at low strength 2.5% at night • Mild erythema-transient • Warn it bleaches clothes • Build up to 10% gradually • Stop if irritation occurs

  7. Acne treatment • Topical retinoids • Start low strength (0.025%)every other night-may cause redness/irritation • Increase strength until response • Avoid sunlight/uv light,not during pregnancy

  8. Acne Treatment • Topical Antibiotics-no better than benzoyl peroxide • Reduces propionobacterium acnes • Less irritation • Topical tetracycline the cheapest • Glows in UV light (warn patient not to go CLUBBING)

  9. Acne treatment • Azelaic acid cream-keratolytic • Alters composition of fat/decrease bacteria • Short term use only • May cause irritation/ photosensitivity

  10. Acne Treatment • Oral Antibiotics • Oxytetracycline 500mg bd • Warn patient can take 6/52 for response-must be compliant.treat for 6 months • Avoid milk,and have 30mins before meals • If effective reduce dose to 500mg od and then 250mg od at 3/12 intervals • DO NOT GIVE WITH TOPICAL ABX-RESISTANCE.CAN COMBINE WITH OTHER TOPICALS

  11. Acne treatment • Oral abx cont… • If initially responds but then gets worse could be due to resistance • Try erythromycin 500mgbd , trimethoprim 100-200mg bd ,doxycycline 100mg od • Minocycline last resort(fears of hepatitis / pneumonitis/ pigmentation) +cost

  12. Acne treatment • Hormonal • In women on OCP consider less androgenic progestogen eg marvelon/cilest, but increased risk of DVT • Consider cyproterone acetate with oestrogen(dianette) .NB endorse perscription with “OC” if patient using as a contraceptive(not licensed as a contraceptive)

  13. Acne- referrals • Refer if very severe or psychological distress • Specialists can prescribe • ISOTREIN(Roaccutane)-specialist only prescription.terratogenic+lots of side effects • UV light • Intralesional steroid injections • High dose antibiotics

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